T-Mobile Wi-Fi X Case Study schizophrenia.docx T 6:18 PM Case Study-NURIS20C-LE-
ID: 136857 • Letter: T
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T-Mobile Wi-Fi X Case Study schizophrenia.docx T 6:18 PM Case Study-NURIS20C-LE-Schizopbrenia Client Profile: Dean, a 48 y o male, grew up on a Pima Indian reservation in Arizona. He lefi the reservation after high school to serve inthe amry, but was diagnosedand treated for schiNphrema?age 21 and was dischargod carly. He has been in and out of psychiatric facilities for sevcral years He periodically takes a bus back to the reservation to sce a medicine man, but he docs nol stay as he has no woek and only distant, poor family there Case Study: Dean has come to the community health center. While he is sitting in the lobby, the nurse observes Dean without him being aware of this. The nurse notices at times he seems to be talking to the air around him. She also notices that Dean is smacking his lips, his tongue peotrudes at times, and he periodically coughs without covering his mou When it is time for the nurse to do an assessment on Dean, the receptionist notiflies the nurse that Dcan has not filled out the intake form. The norse tries to help him by asking him his addross Although his speoch is somewhat disorganizod at times, the narse finds out from Dean hat he is homeless and currently living on the streets. His chief coe plaint is "not feeling well The nurse ukes Dean's vital signs which are: T 100.4. R 22, P 100, and BP 152RK He is 5 foot nches tall and weiphs 235 lbs. When weighod he says he has rocently lost thirty pounds Whon the nurse asks Dean, what medication he is on, he shows bor some empty modicin bottles, saying he has run out of his medication and does not have the moncy to buy more The labels on the bottles indicate he is on metformin, and rispcrodone. The nurse asks him why be s taking risperedone and aso inquires about other medication he has taken in the past. He replies that he was diagnosed with Schizophrenia at age 21 and that he was on Thorazine for several ycars, then haloperidol, then Prolixin injections and maybe some he forpot before the cument risperodone. He explains that he has gone to the community mental health center twice to get more risperodone samples and waited most of the day each time without being seen by psychiatrist. Dean says he either lost or someone stole his last supply ef risperodone, so he has not been taking it for about a month. The nurse sespects that Dean is hearing voices When asked about any health problems, he says he has diabetes, which be is supposed to kep under control "with diet and pills" He also complains of a cough, something he nurse noticed earlier. Afñher the nurse develops some rappoet with Dean, he tells her about secing and hearing an owl that frigheens him. He taks about needing to see a Questions: What are some feelings that murses could have about working with people who are homeless and mentally il, and why would it be important for a nurnse to think ahout his or ber feelings toward this population? 2. Discuss the possible significance of appearance and observed behavie What screening tests andor lab precedures seem to be indicated? What is Tandive Dyskinesia, how common is it, and what is the treatment for ? What did the nurse observe about Dean thait would seggest Tardive DyskinesiaExplanation / Answer
ANSWER 1) Homeless and the mentally ill people belong to the category of vulnerable people. Care for these patients requires one to be sensitive about their issues and should be concerned to provide support and encouragement to lead a positive life. The people who are homeless often suffer from mental stress or illness and have to face social deprivation, neglect and may lack the supplies for their daily living.
While working with such patient, the nurse may be filled with sympathy, empathy and may often be sad or anxious towards giving care to these patients. She may also be encouraged to provide care which may benefit them physicall and mentally. These emotions or feelings of the nurse are important towards the patient as it will help to understand the patient's problem better and to deal with these patients with respect and dignity without any discrimination based on the economic status. It will help the nurse to act efficiently and to utilize the evidenced based practice while developing an appropriate care plan for the patient.
ANSWER 2)Dean who is known schizophrenic and homeless patient, his general appearance and behaviour will be according to his condition.The patient is found talking in air and expressing the presence of some unseen objects, he is smacking his lips, has disorganized speech and has severe weight loss. The hallucinations, disorganized speech are the signs of schizophrenia and the loss of body weight has been resulted from homlessness. His vital signs are also found to be unstable which may indicates the presence of infection due to unhealthy living environments and also the low levels of the antipsychotic medication. Thus the general appearance and the behaviour of Dean will help the nurse and physician to develop a provisional diagnosis of the patient problem.
ANSWER 3) As the patient's temperature is found elevated, a complete blood count and blood culture may be done to rule out presence of any blood infections. Patients blood sugar needs to be checked as he has history of diabetes. Blood test to assess the drug level is orders. Patient may also undergo EEG to monitor the impairement with meurological functioning.
ANSWER 4) Tardative Dyskinesia is a side effect of antipsychotic medication used to treat schizhophrenia and other mental health disorders. Tardative dyskinesia results in jerky, stiff movements of the face and body which is not self controlled. Tardative dyskinesia is not common but it may develop in patients who do not follow the correct regimen of the medication intake. Not all antipsychotic medications precipitate TD.
In order to treat tardative dyskinesia, there two medication which isapproved by FDA for its treatment. They are Valbenazine and Deutetrabenazine. These medications control the flow of dopamine in brain areas which are responsible for these areas. The intake of medication which has resulted in this condition should be stopped or reduced in dose but only after the doctor has been consulted.
In Dean behaviour, his smacking of lips, protrusion of tongue and disorganized speech indicates the presence of tardative dyskinesia.
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